Value Trial: long-term blood pressure trends In 13449 patients with hypertension and high cardiovascular risk

Background: The Vaisartan Antihypertensive Longterm Use evaluation (Value) study compares cardiovascular outcomes in 15,314 eligible patients from 31 countries randomized to valsartan or amlodipine-based treatment. Methods: The blood pressure (BP) trends are analyzed in 13,449 of value study patients who had baseline BP and 24 months BP and treatment data. Results: In a cohort of 12,570 patients, baseline 24 and 30 months BP, but 30 months treatment data, were available. Of 13,449 patients, 92% (n= 12,398) received antihypertensive therapy at baseline, the baseline BPwas 153,5/86,9 mm Hg in treated compared to 168,1,8/95,3 mm Hg in 1051 untreated patients. After 6 months both groups had indistinguishable BP values. At 12 months the BP decreased to 141,2/82,9 mm Hg (p<0,0001 for systolic BP and diastolic BP versus baseline), at 24 months to 139,1/80 mm Hg (p<0,0001 v 12 months), and to 138/79 mm Hg at 30 months (p<0,0001 v 24 months). The systolic BP control (<140 mm Hg) at 30 months increased from 21,9% at baseline to 62,2%, the diastolic BP (<90 mm Hg) from 54,2% to 90,2% and the combined control (<140 and <90 mm Hg) from 18,9% to 60,5%. At 24 months 85,8% of patients were on protocol drugs: monotherapy = 39,7%, added hydrochlorothiazide = 26,6%, add-on drugs = 15,1%, and protocol drugs in nonstandsrd doses = 4,3%. Conclusions: The achieved BP control exceeds values reported in most published large-scale trials, the Value study is executed in regular clinical settings and 92% of the patients received antihypertensive drugs at baseline. When an explicit BP goal is set, and a treatment algorithm is provided, the physicians can achieve better control rates than in their regular practice. AmJ Hypertens 2003; 16: 544-48®2003 American Journal of Hypertension, Ltd.

valsartan, amlodipine, blood pressure response to drugs, pulse pressure